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NAPLEX > Antifungals and Antivirals > Flashcards

Antifungals and Antivirals Flashcards

1
Q

Fungi are classified as one of these 3 things?

A

Yeasts, molds or dimorphic fungi

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2
Q

What are examples of yeasts?

A

Candida species (glabrata, albiancs, tropicalis, parapsilosis, krusei), cryptococcus neoformans

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3
Q

What are examples of molds?

A

Aspergillus species, zygomycetes (Mucor species, rhizopus species)

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4
Q

What are examples of dimorphic fungi?

A

Histo, blasto, coccidio

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5
Q

Of the candida species, which one is most susceptible to drug therapy? Which 2 are generally more difficult to treat?

A

C. albicans is the most susceptible candida species

C. glabrata and C. krusei are generally harder to treat

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6
Q

Amphotericin B (both deoxycholate and all lipid formulations) are active against what and are generally reserved for what types of infections?

A

They are active against yeasts, molds and dimorphic fungi. The problem is side effects.
They are used as initial treatment for invasive infections like cryptococcal meningitits, histoplasmosis and mucormycosis.

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7
Q

BBW associated with amphotericin B

A

Verify product name and dosage. Doses should not exceed 1.5mg/kg/day for conventional formulation. Overdose could result in cardiopulmonary arrest

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8
Q

Side effects of amphotericin

A

Infusion related: fever, chills, HA, malaise, rigors

Others: HypoK, Hypo Mg, nephrotoxicity

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9
Q

Conventional amphotericin requires pretreatment to reduce infusion related reactions. What 4 medications do we normally treat with?

A

APAP or NSAID
Benadryl +/- hydrocortisone
Meperidine to reduce duration of severe rigors
NS bolus to decrease risk of nephrotoxicity

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10
Q

What is the mechanism of action of flucytosine, what drug do we use in combination with this drug and what are the 4 main side effects?

A

Flucytosine penetrates fungal cell walls and gets converted into fluorouracil which interferes with fungal RNA and protein synthesis. Used in combination with amphotericin B for cryptococcal and candida infections.
Side effects: Myelosuppression, increased SCr, increased BUN, hepatitis

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11
Q

Mechanism of action for azole antifungals? They are notorious for what?

A

They decrease ergosterol synthesis and therefore inhibit cell membrane synthesis.
Drug interactions

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12
Q

What is the only azole antifungal that requires renal dose adjustment?

A

Fluconazole

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13
Q

All azole antifungals cover this organism really well?

A

C. albicans, use fluconazole because it has a narrower spectrum compared to other azoles

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14
Q

What is the drug of choice for aspergillus? What do we monitor with this drug?

A

Voriconazole

Visual changes, phototoxicity

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15
Q

other than voriconazole, Which 2 azole antifungals are active against aspergillus and zygomycetes?

A

Posaconazole, isavuconazonium

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16
Q

Which 2 azole antifungals are not equivalent to the suspension dose? Why?

A

Posaconazole, different bioavailabilities in the formulations
Itraconazole (Sporanox)

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17
Q

Ketoconazole has a BBW for what?

A

Hepatotoxicity, use oral tablets only when other agents are unavailable/intolerable

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18
Q

Which azole antifungals are not safe in pregnancy?

A

Voriconazole, fluconazole

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19
Q

All azole antifungals cause which 2 main adverse effects?

A

QT prolongation, increased LFT’s

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20
Q

Voriconazole has activity against which organisms?

A

Aspergillus (first line)

Candida spp. (glabrata, krusei)

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21
Q

Voriconazole has what 4 main warnings associated with its use?

A
  1. Hepatotoxicity
  2. optic neuritis and papilledema
  3. embryofetal toxicity
  4. QT prolongation related to K, Ca, Mg disorders.
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22
Q

Which azole antifungals should be taken with food?

A

Itraconazole (only capsules and tablets, NOT THE SUSP), posaconazole (both susp and caps)

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23
Q

What is the brans name for isavuconazonium sulfate? Warnings and what size filter is used?

A

Cresemba is IV or PO
Warnings: Look for particulates
Requires 0.2-1.2 micron filter during administration not preparation

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24
Q

Which azole antifungals have pH dependent absorption?

A

Ketoconazole and itraconazole

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25
Q

PPIs and cimetidine can decrease absorption of which azole? (drug and formulation)

A

Posaconazole suspension

26
Q

What parameters describe the kinetics of voriconazole? Why is this is an issue?

A

First order, followed by zero order (non-linear kinetics).

Due to CYP interactions the concentration can increase greatly

27
Q

Mechanism of action of echinocandins and their general spectrum of activity?

A

Inhibit synthesis of B 1,3-glucan which disrupts full cell wall production. Active against most candida species

28
Q

Do echinocandins require renal dose adjustment?

A

NO and they are all once daily

29
Q

What are the 3 echinocandins? Brand and Generic. Side effects?

A 
All end in -fungin, all are IV
Caspofungin (cancidas)
Mycafungin (Mycamine)
Anidulafungin
Side effects: Increased LFTS, hypotension, hypoK, HypoMg
30
Q

The one main Contraindication and side effect of griseofulvin?

A

Ctx: pregnancy

Side effect: Photosensitivity

31
Q

2 main side effects associated with Lamisil?

A

Terbenafine

Ha, increased LFTs

32
Q

Important drug interaction with griseofulvin?

A

Decreases efficacy of contraceptives. Recommend non-hormonal

33
Q

First line treatment for C. albicans (thrush) in HIV+ or mod-severe infection? C. albicans esophageal? Bloodstream?

A

Thrush: PO fluconazole
Esophageal: Fluconazole or echinocandin
Candidemia:
If neutropenic: echinocandin (fluconazole alternative)
If not neutropenic: echinocandin, amphoterible, fluconazole (alternative)

34
Q

Preferred treatment for C. glabrata or C. krusei

A

Echinocandin

35
Q

Alternative treatments for aspergillus

A

Voriconazole is preferred, then liposomal ampho or Cresemba

36
Q

Preferred treatment for cryptococcus

A

Amphotericin + flucytosine

37
Q

Preferred treatment for coccidioides?

A

Fluconazole, itraconazole, amphotericin

38
Q

PReferred treatment for histoplasma?

A

Liposomal amphoteicin + itrconazole

39
Q

Preferred treatment for zygomycetes?

A

Amphotericin + posaconazole OR isavuconazonium

40
Q

Preferred treatment for dematophytes (nail bed infections)

A

itraconazole, terbinafine, fluconazole

41
Q

Which drugs are neuraminidase inhibitors? What is their mechanism of action? What types of infections are they active against?

Ideally, when should they be started?

A

Oseltamivir, zanamivir, peramivir.
They inhibit the enzyme responsible for release of new viral particles from infected cells.
They are active against both Flu A/B and they decrease the symptoms by only 1 day and reduce risk of complications associated with flu.
Ideally start within 48 hours to be most effective.

42
Q

Which neuraminidase inhibitor is inhaled? which one is PO? which one is IV?

A

PO: Tamiflu
Inhaled: zanamvir diskhaler (don’t use in asthma/COPD)
Injection: Peramivir: 600mg as single dose

43
Q

Which antivirals are used for herpes simplex and herpes zoster?

A

Acyclovir
Valacyclovir
Famciclovir

44
Q

How do we dose acyclovir in obese people?

A

IBW

45
Q

Regarding genital herpes, when should treatment be initiated to gain full benefit?

A

Within 1 day of lesion onset or during prodrome period (symptoms appear hours-days before lesions appear)

46
Q

If the virus is resistant to acyclovir, it is also resistant to? What should they be treated with instead?

A

Valacyclovir and famciclovir (generally)

Should be treated with foscarnet

47
Q

Recommended treatment (drugs and dosages and duration) for initial episode of HSV infection?

A

Acyclovir: 400mg TID OR 200mg 5x daily
Valacyclovir: 1 gram BID
Famciclovir: 250 TID
ALL 7-10 DAYS

48
Q

Recommended treatment (drugs/dosages/duration) for recurrent episodes of HSV?

A

Acyclovir: 400mg TID X 5, 800mg BID X 5, 800mg TID X 2
Valacyclovir: 500mg BID X 3, 1gm daily X 5
Famciclovir: 125mg BID x 5, 500mg X 1 then 250mg BID x 2 days, 1 gram BID x 1 day

49
Q

Drugs/dosages for chronic suppression of HSV?

A

Acyclovir: 400mg BID
Valacyclovir: 500-1000mg daily
Famciclovir: 250mg BID

50
Q

Drugs/dosages/duration for treatment of initial episode of genital herpes?

A

Acyclovir: 200-400 daily x 5, 400mg TID X 7-10
Valacyclovir: 2 grams BID x 1 day

51
Q

Drugs/dosages/durations to treat recurrent episodes of genital herpes?

A

Acyclovir: 200-400 5 times daily, 400 TID, 800 BID (all 5 days)
Valacyclovir: 2grams BID x 1 day
Famciclovir: 1.5gm X 1 dose

52
Q

Drugs/dosages/ for chronic suppression of genital herpes?

A

Acyclovir only drug for this. 400mg BID

53
Q

The shingles rash is cause by what? describe the rash

When should therapy be initiated in someone who develops shingles?

A

Caused by herpes zoster. Itchy, tingly and very painful (cluster, fluid filled)
Ideally, we want to start therapy within 72 hrs to be most effective

54
Q

Drugs/dosages/duration to treat shingles?

A

Acyclovir: 800mg 5x daily X 7-10
Valacyclovir: 1g TID x 7
Famciclovir: 500mg TID x 7

55
Q

Which 4 drugs are approved to treat cytomegalovirus (CMV)?

Which 2 of these 4 are treatment of choice?

A

Ganciclovir*
Valganciclovir*
Cidofovir
Foscarnet

56
Q

What is the generic of Valcyte? Which drug is this drug a prodrug of?

A

Valgancyclovir, prodrug of ganciclovir

57
Q

BBW, side effects of ganciclovir and valganciclovir?

A

BBW: Bone marrow suppression

Side effects: Thrombocytopenia, neutropenia, leukopenia, anemia

58
Q

Which antiviral used to treat CMV comes in a suspension that requires refrigeration?

A

Valganciclovir (discard after 49 days)

59
Q

Which antiviral is only approved in HIV patients with CMV retinitis?
BBW with this drug?

A

Cidofovir

Nephrotoxicity

60
Q

2 BBW and 1 major side effect with foscarnet?

A

BBW: Renal impairment, electrolyte imbalances

Side effects: increased SCr

61
Q

EBV is another name for what? How is it transmitted?

What treatment is available?

A

Mononucleosis
Transmitted by saliva, kissing sharing drinks etc.
No drug treatment or vaccines

NAPLEX (30 decks)

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